• 대한정형외과 초음파학회지
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• 제4권1호
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• pp.33-37
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• 2011

어깨의 통증을 유발하는 흔하지 않은 원인 중 하나인 상부 관절와순 전후방 병변과 동반된 극관절와 낭종에 대한 보고는 많지 않다. 저자들은 이학적 검진과 초기 초음파 검사로 극관절와 낭종을 발견하지 못한 증례를 경험하였으며, 추가로 이학적 검진과 자기공명영상 및 상지 근전도 검사로 확인하여 수술적 치료를 시행하였다. 어깨의 통증과 근력 약화를 보이는 환자에서 초음파 검사로 명확한 원인이 발견되지 않을 경우 자세한 이학적 검진과 자기공명영상, 근전도 검사 등 추가 검사가 필요할 것으로 사료된다. 극관절와 낭종에서 초음파 검사는 제한점을 가질 수 있으며, 특히 극관절와 낭종의 (1) 크기가 작고, (2) 위치상 깊이가 깊으며, 견갑극을 따라 상부 관절와순 전후방 병변에서 발생한 경우 초음파 검사에서 관찰되지 않을 수 있다는 것을 임상의들은 염두에 두어야 할 것으로 사료된다.

• Clinics in Shoulder and Elbow
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• 제18권2호
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• pp.86-90
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• 2015

Background: Although there are several methods for evaluating bone quality, Hounsfield units (HU), a standardized computed tomography (CT) attenuation coefficient, provide a useful tool for estimating focal bone mineral density (BMD). The aim of this study is to investigate the HU for evaluating the degree of osteoporosis in greater tuberosity with regard to anchor positioning. Methods: Forty patients diagnosed as normal on shoulder CT were included and categorized according to age and gender. Axially sectioned CT images were processed to 3-dimensional models containing information about bone quality using Mimics (14.11 platform v14.1.1.1 Materialise). Three-dimensional anchors were simulated and positioned according to 6 regions of interest (ROI) in the greater tuberosity classified using Tingart's system. Mean HU of intra-anchor volumes in the 6 regions was measured. Results: A significant decrease in HU was observed with increasing age (p=0.0001) and menopause (p<0.001). A significant difference in HU was found between male and female groups with males showing the higher values (p=0.0001). HU of proximal areas of ROI was higher than those of distal areas (p<0.005). However, although mean HU of distal posterior ROI showed the lowest values, no statistically significant difference was found between anterior, middle, and posterior regions (p=0.087). Conclusions: Mean HU of ROIs provides a tool for preoperative assessment of focal BMD, which is a factor of suture anchor stability and can be used to aid decision-making regarding secure anchor positioning for rotator cuff repair. Our data support that the most secure point is the proximal regions of ROI.

• Clinics in Shoulder and Elbow
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• 제14권1호
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• pp.111-116
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• 2011

목적: 저자는 견관절 역형 전 치환술 후 중기 추시 결과와 합병증에 대해 알아보고자 하였으며 결과에 영향을 미치는 요인에 대해 분석하고자 하였다. 대상 및 방법: 역형 치환술 후 중기 추시를 보고한 문헌의 체계적인 분석을 시행하였으며, 수술후 문제점, 합병증, 재 수술, 재 치환술의 전반적인 발생율을 조사하였다. 결과: 보고되고 있는 합병증율은 0~68%로 다양하다. 최소 2년 이상 추시된 역형 치환술의 초기 예비 보고들은 우수한 기능적 결과를 나타내고 있다. 그러나 중기 추시된 문헌상 보고의 체계적인 분석 결과는 44%의 문제점, 24%의 합병증, 3.5%의 재 수술, 10%의 재 치환술을 나타냈다. 결론: 역형 전 치환술은 상대적으로 높은 합병증과 재 치환율을 나타낸다. 따라서 역형 치환술은 회전근 개 광범위 파열을 가진 매우 심한 관절병증의 환자에서 주로 시행되어야 하며 70세 (최소한 65세) 이상에서 시행되어야 한다.

• 대한물리의학회지
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• 제10권1호
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• pp.63-69
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• 2015

PURPOSE: Low-intensity exercise with transient restriction of blood flow to muscle could be an alternative rehabilitation method which avoids the problems associated with conventional high-intensity exercise. However, the mechanism of low-intensity exercise with transient restriction of blood flow is not clearly known. Thus, the purpose of this study was to investigate the mechanism of improvement of muscular function after low-intensity exercise with transient restriction of blood flow using H-reflex analysis. METHODS: Twenty one healthy young adults with no medical history of neurological or musculoskeletal disorder voluntarily participated in this study. The ${\alpha}$-motor neuron excitability of the triceps surae was assessed using the H-reflex. The amplitude of the M-wave and H-reflex were measured across three conditions: rest, after low-intensity exercise without restriction of blood flow and after low-intensity exercise with restriction of blood flow. The subjects performed low-intensity ankle plantar flexion exercise at their own pace for one minute without or with transient restriction of blood flow achieved by a sphygmomanometer cuff on popliteal fossa at a pressure of 120mm of mercury(120 mmHg). RESULTS: No significant changes of the excitability of the ${\alpha}$-motor neuron were obtained across three different conditions. CONCLUSION: This study found that low-intensity exercise with transient restriction of blood flow did not influence to ${\alpha}$-motor neuron excitability of the triceps surae. From the results, I could come to the conclusion that further study will be required.

• 대한물리의학회지
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• 제2권2호
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• pp.243-250
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• 2007

Purpose : Shoulder subluxation is a very common problem in patients with hemiplegia with stroke. Prevention of the low tone subluxed shoulder has been an issue for physical therapists working with neurological patients for many years. Methods : This study reviewed the literature to definite the management and a cause of shoulder subluxation with hemiplegia patients after stroke. Various modalities have been suggested for realigning the glenohumeral joint, but their use is controversial. The purpose of this paper is to review critically the evidence base in order to inform the clinical decision-making process for physiotherapists working in neurology. Results : Literature has identified supports, strapping and functional electrical stimulation(FES) in the management of low tone shoulders. Following review of this evidence it is suggested that there is a lack of reliable and valid research evidence on which to base conclusions. The modalities with the best supporting evidence for realigning the low tone subluxed glenohumeral joint are the triangular sling, Harris hemi sling and the Rolyan humeral cuff used in a standing position and the lap board and arm trough while the patient is sitting. However, due to soft tissue adaptation with associated lack of movement, over-correction and the need for careful patient positioning these supports need to be evaluated for each patient and should be used only in appropriate situations. Conclusion : Similarly, there is a lack of evidence on the effects of long-term use to this equipment. Electrical stimulation is also thought to have potential in the treatment to subluxed low tone shoulders but additional research is required to clarify the parameters for use and the long-term effects of these forms of management.

• Journal of Chest Surgery
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• 제29권2호
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• pp.235-238
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• 1996

후천성 기관식도루는 드문 질환이 지만 생명을 위협하는 병변이며 원인중에는 cuff가 있는 tube를 삽관하여 부적절한 관리하에 장기간 인공호흡기 치료를 한 환자에서 발생하는 경우가 가장 많다. 손상의 기전은 cutt에 의해 기관벽에 압력이 가해져서 허혈성 손상과 더불어 염증성 반응이 더해져 압박된 식도와 비정상적 교통이 생기는 것으로 여겨지고 있다. 환자는 25세된 임산부로 중이염의 합병증으로 세균성 뇌막염이 발생하여 장기간의 인공호흡기 치료중 갑작스런 피하기종과 종격동기종이 발생하여 기관지 경과 CT를 이용해 기관식도루가 발생 했음을 확인후 본과에서 수술적 치료를 시행하였다. 수술은 자동봉합기로 기관의 손상부위를 봉합하고 식도 부위는 vlcyl과 Prolene으로 내외층을 단순봉합하였으며 기관과 식도사이에 흉쇄유돌근 절편을 끼워 넣었다. 수술 후 10일째 식도조영술로 기관식도룬가 완전복구되고 식도기능이 정상임을 확인하였으며 퇴원 후 추적조사결과 환자는 별 문제없이 잘 지내고 있다.

• Clinics in Shoulder and Elbow
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• 제8권1호
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• pp.23-30
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• 2005

Purpose: This paper analyzes the results of arthroscopic bankart repair for anterior recurrent dislocation following a trauma on shoulder. Material and Methods: The subjects were twenty-three (23) cases that were available to follow up for more than eighteen months during the period from November 2001 to June 2003 and were chosen from patients to whom arthroscopic bankart repair was applied using a knotless suture anchor for their traumatic anterior recurrent dislocation on the shoulder. Their average age was 28 (ranging from 15 to 60) with 20 males and 3 females. The injury from sports activities accounted for the most cases with 14 subjects. The average follow-up period was 27 months (ranging from 18 months to 35 months). There were 19 cases of bankart lesions, 4 cases of ALPSA lesions and associated with 5 cases of partial tear in the rotator cuff. The anchors employed were knotless anchor (Mitek) for all the cases. Rowe scoring scale was adopted to judge the results after operations. Patients' subjective satisfaction and range of motion of external rotation were addressed together. Results: Rowe scores showed that 20 cases (87%) reaches the level of 'good' and hinger. The average patients' satisfaction accounted for 90 points out of 100. It was also found that external rotations averagely decreased by 6.5 degree when the range of motion was in at the side. Conclusion: There were satisfactory results of arthroscopic bankart repair using knotless suture anchors as an operative treatment for traumatic anterior recurrent dislocation on shoulder.

• Clinics in Shoulder and Elbow
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• 제20권1호
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• pp.30-36
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• 2017

Background: Isolated infraspinatus tear is very rare and clinical features are not as well known, therefore the purpose of this study was to evaluate clinical characteristics and outcomes of isolated infraspinatus tear that authors experienced. Methods: Authors reviewed 288 cases of full-thickness rotator cuff tear involving infraspinatus between 2010 and 2015, and retrospectively analyzed six cases of isolated infraspinatus tear. Perioperative clinical characteristics, postoperative functional outcomes of 6 months were investigated. Functional evaluation included visual analogue scale (VAS), range of motions, American Shoulder and Elbow Surgeons (ASES) score, and Constant score. Results: Calcific tendinitis was accompanied in 4 cases (66.7%). Three of them received steroid injection or aspiration or extracorporeal shockwave therapy. Mean preoperative pain VAS was 7.1 (range, 5-9), and mean postoperative pain VAS at 6 months later was 1.6 (range, 0-5). Preoperative muscle strength by isokinetic muscle performance test showed 52% deficit of abduction and 37.6% deficit of external rotation. All 6 patients had arthroscopic repair of the infraspinatus tendon. All the patients at the 6 months follow-up exhibited clinical improvement in the Constant score (67.8 [range, 45-77] to 89.3 [range, 81-100], p=0.029), and ASES score (52.3 [range, 30-77] to 90.0 [range, 80-100], p=0.002). There was no healing failure on imaging. Conclusions: Isolated infraspinatus tendon tear was frequently accompanied by calcific tendinitis, but pathophysiologic relationship should need more study. To rule out neurogenic etiology, magnetic resonance imaging and electromyography would be helpful. Arthroscopic infraspinatus tendon repair and supraspinatus debridement showed relatively good result in painful shoulder.

• Clinics in Shoulder and Elbow
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• 제17권1호
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• pp.18-24
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• 2014

Background: To evaluate the efficacy of the subclavian portal approach for the arthroscopic repair of isolated subscapularis tendon tear. Methods: We used the subclavian portal to carry out arthroscopic repair of the isolated subscapularis tendon tear. The surgery was carried out in 18 cases (average age of 53) from May 2006 to December 2009 with a mean follow-up period of 35 months. Of these cases, 13 patients had the tear in their dominant arms, 16 were male, and 12 were from traumatic ruptures with on average 7.6 months of symptom period to operation. Additional surgery, acromioplasty and subacromial debridement, were carried out on 4 cases each during the subscapularis repair. The integrity of cuff status was assessed by ultrasonographic examination at 6 months and at 1 year after operation. Results: The initial average range of motion in forward flexion, external rotation, and internal rotation were $160^{\circ}$, $50^{\circ}$ and L4, respectively. At the 1 year follow-up period, these improved to $160^{\circ}$, $52^{\circ}$ and T12, respectively. The initial average functional scores were assessed by KSS, ASES, UCLA, and Constant scoring systems, which were 67, 60, 26, and 65, respectively. These scores improved progressively with time. At 3 months after operation, the scores were 74, 67, 27, and 74; at 6 months, 83, 77, 31, and 75; at 1 year, 88, 86, 32, and 79; and at the final follow-up of 35 months, 84, 92, 34, and 84. Conclusions: In the repair of isolated subscapularis tendon tear, the subclavian portal approach provided a good angle for anchor insertion and sufficient space to manage the upper portion of the tendon tear. In turn, these provisions resulted in satisfactory clinical results.

• Journal of Ginseng Research
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• 제40권3호
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• pp.237-244
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• 2016

Background: Ginsenoside Rg3 and arginine-fructose (Arg-Fru) are known as the hypotensive compounds of Panax ginseng; however, their efficacy on antihypertension has not been reported yet to our best knowledge. Thus, hypotensive components-enriched fraction of red ginseng (HCEF-RG) was prepared from fine root concentrate (FR) and their antihypertensive effects were investigated in spontaneously hypertensive rats (SHR). Methods: Male SHRs were divided into six groups: control (Wistar Kyoto, SHR); FR 500; FR 1,000; HCEF-RG 500; and HCEF-RG 1,000; samples (mg/kg body weight) were orally administered every day for 8 wk. Blood pressure was monitored at 1 wk, 2 wk, 3 wk, 4 wk, 6 wk, and 8 wk by tail cuff method. At 8 wk after samples administration, mice were killed for the measurement of renin activity (RA), angiotensin-I converting enzyme inhibition, angiotensin II, and nitric oxide (NO) levels in plasma. Results: HCEF-RG with four-fold more Rg3 and 24-fold more Arg-Fru contents was successfully prepared from reacted mixtures of FR and persimmon vinegar (12 times against FR, v/v) at $80^{\circ}C$ for 18 h. Both FR 1,000 and HCEF-RG 1,000 showed lowered systolic blood pressure than SHR control group and HCEF-RG 1,000 group exhibited a significant decrease in diastolic blood pressure. RA was significantly lowered in all treated groups, while angiotensin II did not affect by FR and HCEF-RG treatment. However, angiotensin-I converting enzyme inhibition and NO in FR 1,000 and HCEF-RG 1,000 were significantly increased compared with SHR control group. Conclusion: HCEF-RG is more effective and useful for alleviating hypertension than FR, implying the health benefit of Rg3 and Arg-Fru.